Physical findings & Clinical Presentation:
â€¢ Severeconstant pleuritic pain that localizes over the anterior chest and may radiateto arms and back; it is differentiated from myocardial ischemia, becausethe pain intensifies with inspiration and is relieved by sittingup and leaning forward.
â€¢ Pericardial friction rub is best heard with patientupright and leaningforward and by pressing the stethoscope firmly against the chest; itconsists of three short, scratchy sounds:
â€¢ Signs and symptoms:
- Interscapular pain
- Refractary hypotension
- Distended neck veins
- Chest x-ray: Cardiomegaly, clear lungs (may be normal)
- ECG: Low amplitude of QRS, electrical alternans
Immediatepericardiocentesispreferably by needle paracentesis with the use of echocardiography, fluoroscopy,orCT Aspirated fluidshould be sent for analysis (protein, LDH, cytology, CBC, Gram stain, AFBstain) and cultures for AFB, fungi, and bacterial C&S.
Jon Mikel IÃ±arritu, M.D.